Trends in pregnancy-related smoking rates in the United States, 1987-1996

Context Rates of smoking are increasing among adolescents and young adults, but trends in smoking among pregnant women have not been studied, Objective To assess pregnancy-related variations in smoking behaviors and t heir determinants among women of childbearing age in the United States, Design Analysis of data collected between 1987-1996 from the Behavioral Ris k Factor Surveillance System survey. Setting and Subjects A total of 187 302 (178 499 nonpregnant and 8803 pregn ant) noninstitutionalized women aged 18 to 44 years from 33 states. Main Outcome Measures Prevalence rates of smoking initiation and current sm oking, median number of cigarettes smoked, and adjusted odds ratios for smo king stratified by pregnancy status; prevalence rate ratio for current smok ing comparing pregnant with nonpregnant women, Results The overall percentage of women who had ever initiated smoking decr eased significantly from 44.1% in 1987 to 38.2% in 1996, During that 10-yea r period, the prevalence of current smoking also decreased significantly am ong both pregnant women (16.3% to 11.8%) and nonpregnant women (26.7% to 23 .6%), Overall, pregnant women were about half (54%) as likely as nonpregnan t women to be current smokers during 1987-1996. Over time, the median numbe r of cigarettes smoked per day by pregnant smokers remained at 10, whereas among nonpregnant smokers it decreased from 19 to 15 (P<.05 for trend). in the same period, among young women (aged 18-20 years), prevalence rates of smoking initiation and current smoking increased slightly, Sociodemographic subgroups of women at increased risk for current smoking were the same for pregnant and nonpregnant women tie, those with a completed high school edu cation or less, whites, and those who were unmarried). Conclusions In this analysis, the decline in smoking over time among pregna nt women was primarily due to the overall decline in smoking initiation rat es among women of childbearing age, not to an increased rate of smoking ces sation related to pregnancy. To foster effective perinatal tobacco control, efforts are needed to further reduce the number of young women who begin s moking. Clinicians should query all pregnant women and women of childbearin g age about smoking and provide cessation and relapse interventions to each smoker.